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Home My WebLink About9263-z FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE V~'ORK AUTHORIZED) N? 9263 Z Permission is hereby granted to: ...~.~.~.~ ...... ~ ....... .~./..~.!~..,.V..E..,.~..~.~?.~ .... ......L..?..L....L.~ ........... ...~....~.....z.. ....... ~.~.....~.~.~......~./.~.~. .......... .~..~. ...... .~.~.~ .... pursuant to application dated ....................... ' .......... ~...~....~.~[..:~., 19.?.7..., and approved by the Building Inspector. Building Inspector Examined Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No ...... 2.~......~....~,..~ ^pplicotion No. ,~..~- ~ '~ Disapproved a/c ........................... ~.~........._...._._... ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT .......................... I NSTI~UCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s applicatic c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ti Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and iN buildings for necessary inspections. ~/ (5igl pp ' , r~ , 'f corporatio~ .... ....... ........... ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or build.- ........................ .................................................................................................................................................. Name of owner of premises ............ ..~....O...g.~.?..~......~.......~.. ......... .~.6..N.......-~....~...~..~..~.~.~..~ ..................................... If applicant is a co~orate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................... ~..?[....-C....~. ............. Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Locat,on of land on which proposed work will b~e done. Map No .... .~.Z..~..~ ................. Lot No ..... L.~.. ........... Street and Num~.....~.~.~......~.~.~Z ..... '~'~'~'~"'t ...... ~.~.~9~ ................................... Municipali~ State existing u~ and occupancy of premises and intended use and ~cupancy of proposed construcbon: a Exisit,ng use and ~cupancy ................. J....~.~.~. t..~ .......... ~..~.~.~.J.~.~ ......................................... b. ,t ,ded u,. c,p.,cv ....... ........ ......... .................................................. 3 Nature of work (check which applicable) New Budding ............... Addition ................. Alteration ............. Repair ............... Removal ............... Demoht,or ......... Other Work .... /..- .~..../.~.~...~... .................. ~/5' 0 ~ ~/~ ~c~,p~,o~ 4 Estimated Cost ..................................................... Fee ........ t.~. .................................................................. (to be prod on fihng th~s apphcahon) 5 If dwelling, number of dwelhng units ..................... Number of dwelhng umts on each floor ....................... If garage, number of ~rs ............................. 6 If business, commercial or m~xed occupancy, specify nature and extent of each ~pe of use ......................... 7 D~mens~ons of ex~stmg structures, ,f any. Front ...................... Rear ................................Depth .................... Height ........................ Number of Storms ...................................................................................................... D~mens~ons of same structure with alterations or addmons' Front ................................... Rear .................... Depth ............................... Height .................... Number of Stones ............................. 8 D~mens~ons of enhre new construchon Front .................................. Rear ............................ Depth ........ Height ................. Number 9 S,ze of lot: Front ..... ~..~...~..~..~ ...................... Rear ...................................... Depth .(~.~...~..L~ .... 10 Date of Purchase .................................................. Name of Former Owner ...................................................... 11. Zone or use d,str,ct ,n whmh premises are s~tuated ............ ~]~.~.~.~.(..~.( ..................................... 12 Does proposed construction violate any zoning law, ordinance or regulahon 13. Wdl lot be regraded ....................... W~II excess fill be removed from premises. ( ) Yes ( ~No 14 Name of Owner of prem,ses .... .~....~.~.~.~.~.~0 ~ ....... Address ~.~ ......... Phone No ..................... Name of Architect ......................................... Address ................................Phone No ..................... Nome of Contractor .......... ~ .............. Address ................................Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and mdmate all set-~ck d~mens~ons fro propc~y hnes Gwe street and block number or descnpt~on according to deed, and show street names and indma whether interior or corner lot_ STATE OF NEW YORK,~,~ lc S cou~w o~ ........ ~.'... ....... .......... ~.~ .........~.~.~.~.~...~.~(.~ ..................being duly sworn, deposes and says that he ,s the appho (Nome of mdlwdual signing contract) above named ~e ,~ ,he ............ ~.~..~.~.~,. ............................................................................................................................ (Contractor, agent, corporate officer, etc ) of satd owner or owners, and Is duly authorized to perform or have performed the sa~d work and to make and this opphcot~on; that oil statements contained tho~ the work w~ll be performed m the manner set fo~h m the opphcahon filed therewith. Sworn to before me thru ............... ...................... ................. : ............................ ........... ~o, 52-~643~2[, Suffolk ~erm ~res March 30, 19~